The effect of cyclooxygenase-2 inhibitors on bone mineral density: results from the Canadian Multicentre Osteoporosis Study
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Published on: May 9, 2019
J B Richards1, L Joseph, K Schwartzman
1Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.
Introduction:
The use of cyclooxygenase-2 (COX-2) inhibitors has been demonstrated to not only impair load-induced bone formation but also prevent menopause-associated bone loss. We hypothesized that COX-2 inhibitor use would be associated with increased bone mineral density (BMD) in postmenopausal women not using estrogen therapy and, conversely, with decreased BMD in men.
Methods:
The Canadian Multicentre Osteoporosis Study is a longitudinal, randomly selected, population-based community cohort. We present data from men (n=2,004) and postmenopausal women age 65 and older (n=2,776) who underwent a BMD measurement and structured interview in the 5th year of the study. The outcome measure was percent difference in BMD (g/cm(2)).
Results:
Daily COX-2 inhibitor use was reported by 394 subjects. In men, daily use of COX-2 inhibitors was associated with a lower BMD at all hip sites, with a percent difference of -3.1% [95% confidence interval (CI), -6.0, -0.3] between users and nonusers at total hip. In postmenopausal women not using estrogen replacement therapy, daily COX-2 inhibitor use was associated with higher BMD at most sites [percent difference at total hip: +3.0% (95% CI, 0.3, 5.8)]. These effects appeared to be dose-dependent.
Conclusion:
COX-2 inhibitor use was associated with a lower BMD in men and, on the other hand, with a higher BMD in postmenopausal women not using estrogen replacement therapy. Men who have used COX-2 inhibitors may wish to seek BMD measurement to assess their fracture risk. However, COX-2 inhibitors may have utility in postmenopausal women if bone-selective analogs can be developed.
Insights
Cyclooxygenase-2 (COX-2) inhibitors lower bone mineral density (BMD) in men but increase BMD in postmenopausal women not on estrogen therapy. Men using COX-2 inhibitors should monitor BMD for fracture risk.
Area of Science:
- Bone Metabolism and Pharmacology
- Geriatric Medicine
- Rheumatology
Background:
- Cyclooxygenase-2 (COX-2) inhibitors influence bone formation and loss.
- Menopause is associated with bone loss, while COX-2 inhibitors may affect bone density differently in men and women.
Purpose of the Study:
- To investigate the association between COX-2 inhibitor use and bone mineral density (BMD) in men and postmenopausal women not using estrogen therapy.
Main Methods:
- Analysis of data from the Canadian Multicentre Osteoporosis Study, a longitudinal cohort study.
- Included 2,004 men and 2,776 postmenopausal women aged 65+ with BMD measurements and interviews.
- Outcome measured was the percent difference in BMD (g/cm(2)) between users and non-users of COX-2 inhibitors.
Main Results:
- Daily COX-2 inhibitor use was linked to lower BMD in men, with a -3.1% difference at the total hip.
- In postmenopausal women not on estrogen therapy, COX-2 inhibitor use correlated with higher BMD, showing a +3.0% difference at the total hip.
- Observed dose-dependent effects for COX-2 inhibitor use on BMD.
Conclusions:
- COX-2 inhibitor use is associated with decreased BMD in men and increased BMD in postmenopausal women not on estrogen therapy.
- Men using COX-2 inhibitors may need BMD monitoring to assess fracture risk.
- Potential therapeutic utility of COX-2 inhibitors in postmenopausal women warrants further investigation, possibly through bone-selective analogs.
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